Individual
QUETZAL ATHENA CLASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
355 W 16TH ST, SUITE 2800, INDIANAPOLIS, IN 46202-2207
(317) 963-7308
(317) 963-7325
Mailing address
355 W 16TH ST, SUITE 2800, INDIANAPOLIS, IN 46202-2207
(317) 963-7308
(317) 963-7325
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
06/02/2014
Last updated
06/02/2014
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